术前膝关节松弛对前交叉韧带部分重建术后临床疗效的影响。

Effects of pre-operative knee laxity on clinical outcomes after partial anterior cruciate ligament reconstruction.

作者信息

Li Bin, Wang Guang-Bin, Wang Yan-Fang, Zhou Bing-Zheng

机构信息

Department of Joint Surgery and Sports Medicine, Shengjing Hospital, China Medical University, Shenyang, China.

Department of Joint Surgery and Sports Medicine, Shengjing Hospital, China Medical University, Shenyang, China.

出版信息

Knee. 2018 Jun;25(3):445-452. doi: 10.1016/j.knee.2018.02.012. Epub 2018 Apr 21.

Abstract

BACKGROUND

The effects of retaining residual bundles on surgical outcomes has not been observed, so we evaluated the effects of preoperative knee laxity on clinical outcomes after partial anterior cruciate ligament (ACL) reconstruction for partial ACL rupture in this study.

PURPOSE

To evaluate the effects of preoperative knee laxity on clinical outcomes after partial anterior cruciate ligament (ACL) reconstruction for partial ACL rupture.

METHODS

The data of 47 patients, who had partial ACL rupture and underwent partial ACL reconstruction, were retrospectively analyzed. According to preoperative kneelax arthrometer and pivot shift test, the 47 patients were divided into group A (kneelax arthrometer ≤5mm and pivot shift test <II grade, n=26) and group B (kneelax arthrometer >5mm and/or pivot shift test ≥II grade, n=21). The minimum follow-up duration lasted 2 years. The clinical outcomes were evaluated using IKDC (International Knee Documentation Committee) scoring systems, Lysholm knee scoring scale, Tegner activity rating, Lachman test, Pivot shift test and the kneelax arthrometer.

RESULTS

The function and stability examinations for the affected knee joint were significantly improved in both groups after partial ACL reconstruction as compared with preoperative ones (all P<0.01). There were no significant differences in the post-operative Lysholm and Tegner scores, Lachman and Pivot shift test results between both groups (all P>0.05). However, there were significant differences between the two groups in terms of the post-operative IKDC scoring system and kneelax arthrometer examination result (all P<0.05).

CONCLUSIONS

In the patients with partial ACL rupture, the mechanical strength of the remnant ligament has significant influence on the therapeutic effects of partial reconstruction. The patients with kneelax arthrometer >5mm and/or pivot shift test ≥II grade still have anterior instability in the affected knee after partial reconstruction.

摘要

背景

保留残余束对手术结果的影响尚未见报道,因此在本研究中我们评估了术前膝关节松弛度对部分前交叉韧带(ACL)断裂行部分ACL重建术后临床结果的影响。

目的

评估术前膝关节松弛度对部分前交叉韧带(ACL)断裂行部分ACL重建术后临床结果的影响。

方法

回顾性分析47例部分ACL断裂并接受部分ACL重建患者的数据。根据术前膝关节松弛度测量仪及轴移试验,将47例患者分为A组(膝关节松弛度测量仪≤5mm且轴移试验<Ⅱ级,n = 26)和B组(膝关节松弛度测量仪>5mm和/或轴移试验≥Ⅱ级,n = 21)。最小随访时间为2年。采用国际膝关节文献委员会(IKDC)评分系统、Lysholm膝关节评分量表、Tegner活动评分、Lachman试验、轴移试验及膝关节松弛度测量仪评估临床结果。

结果

与术前相比,两组患者行部分ACL重建术后患膝关节的功能及稳定性检查均有显著改善(均P<0.01)。两组术后Lysholm和Tegner评分、Lachman试验和轴移试验结果比较,差异均无统计学意义(均P>0.05)。然而,两组术后IKDC评分系统及膝关节松弛度测量仪检查结果比较,差异均有统计学意义(均P<0.05)。

结论

在部分ACL断裂患者中,残余韧带的机械强度对部分重建的治疗效果有显著影响。膝关节松弛度测量仪>5mm和/或轴移试验≥Ⅱ级的患者在部分重建术后患膝仍存在前向不稳。

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